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Intake + Waiver

Thank you for taking the time to complete this Intake Form and Waiver. If you have any questions, please email me, katie@glowithin.ca. I look forward to learning and growing with you!

~ Katie

ONLINE SESSIONS: You understand that you are responsible for your health and wellness in any online class you partake in, including the safety of the space in which you are using. You also understand that classes may be recorded for marketing or other purposes. Katie will email you again to confirm it is ok to share any images prior to sharing for marketing purposes. 

IN PERSON SESSIONS: 

Declaration of Health: You declare that:

You have not experienced any symptoms of COVID-19, including shortness of breath, sore throat, runny nose, cough, fever or difficulty breathing in the last fourteen (14) days;

If You have exhibited any symptoms discussed in subsection (i) of this paragraph, You agree to cancel your appointment with and not enter premises where this service is being provided.(ii) have not been in close contact with a person diagnosed with, or suspected of being infected by COVID-19;You have self-isolated for a period of 14 days from the date of your return to Canada (if applicable), from the last date of contact with a person diagnosed with, or suspected of being infected by COVID-19, or the date you first experienced symptoms of COVID-19;

You release Katie Connolly/ Joie de Vivre Yoga (dba gloWithin) from responsibility and/or liability of any harm incurred during or while receiving services;

Health Policies: You agree to abide by the health policies set out at the location where this service is offered, including recommendations from British Columbia Health Authorities and the Government of British Columbia. You agree to:

(i) Stay home and keep a safe distance from family when you have cold or flu symptoms, including coughing, sneezing, runny nose, sore throat, fatigue, difficulty breathing;

(ii) Practice good hygiene, including, regularly washing your hands, avoiding touching your face, covering coughs and sneezes with your sleeve or the inside of your elbow, disinfecting frequently touched surfaces; and

WAIVER & RELEASE: Please read the following in its entirety. This document (“Waiver”) sets out the terms and conditions that govern service(s) provided to you as an individual (“You”, “Your”) by Katie Connolly/Joie de Vivre Yoga (dba gloWithin) and any teachers or guest speakers affiliated with gloWithin, henceforth referred to as gloWithin (“I”). By signing this Waiver, you agree to be bound by, and to comply with the terms of the Waiver.

Assumption of Risk: You are aware that Yoga and Craniosacral and Somatoemotional Release activities may involve risks, dangers, and hazards. 

Release of Liability, Waiver of Claims & Indemnity Agreement: In consideration of gloWithin allowing You to participate in Yoga and Craniosacral and Somatoemotional Release Activities, and for other good and valuable consideration the receipt and sufficiency of which is acknowledged, YOU HEREBY IRREVOCABLY AGREE AS FOLLOWS:

1. TO WAIVE ALL CLAIMS that You have or may in the future have against gloWithin and TO RELEASE gloWithin from any and all liability for any loss, damage, expense, or injury including death that You may suffer, or that Your next of kin may suffer, resulting from either Your use of or Your presence at the premises DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, NEGLIGENT MISREPRESENTATION OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE (INCLUDING ANY DUTY OF CARE UNDER THE OCCUPIERS LIABILITY ACT, R.S.B.C. 1996, c.337) ON THE PART OF KTC, AND ALSO INCLUDING THE FAILURE ON THE PART OF KTC TO SAFEGUARD OR PROTECT YOU FROM THE RISKS, DANGERS, AND HAZARDS OF YOGA ACTIVITIES;

2. TO INDEMNIFY AND SAVE HARMLESS gloWithin from any and all liability for any damage to property or personal injury of any nature to any third party, resulting from Your use of or presence on the premises and Your participation in Yoga and Craniosacral and Somatoemotional Release Activities;

3. If medical care is rendered to You as a result of injury, You consent to that care if You are unable to give consent for any reason at the time the care is rendered;

4. This agreement is effective and binding upon your heirs, next of kin, executors, administrators, assigns, and representatives, in the event of your death or incapacity;

5. This agreement and any rights, duties, and obligations as between the parties to this agreement shall be governed by and interpreted solely in accordance with the laws of the Province of British Columbia and no other jurisdiction; and

6. Any litigation involving the parties to this agreement must be brought within the Province of British Columbia and the parties attorn to the exclusive jurisdiction of the Courts of the Province of British Columbia.

AGREEMENT: You are not relying on any oral or written statements made by gloWithin with respect to the safety of Yoga and Craniosacral and Somatoemotional Release Activities and sharing a common space other than what is set forth in this Waiver. You confirm that, before signing this Waiver, You have read and understood it and You are aware that by signing this Waiver, You are waiving certain legal rights which You or Your heirs, next of kin, executors, administrators, assigns, and representative may have against gloWithin. By signing below, You acknowledge that You have read and understand this waiver and You voluntarily agree to the terms and conditions listed above.

Refund Policy

  • Up to 1 month prior to start – full refund less Administration Fee of $50
  • Up to 2 weeks prior to start- 50% refund less Administration Fee of $50
  • Once begun, no refunds given

We understand that sometimes urgent or health situations arise and may be prolonged. These situations will be handled case by case. Should you need to request a refund, please email Katie@glowithin.ca. Refunds will be processed in the same format received.

 

Name, Relationship, Phone #
How would you describe your current self-care + yoga practice (asana, meditation, breathwork)? It's ok if you're a beginner too!
How is your general health - sleep, digestion, energy? Are there any emotional concerns?
Do you have a history of heart concerns, concussions, migraines, dental work, allergies, surgery, or anything else you feel I should know? Please elaborate if yes.